Type of Attending Obstetrician Call Schedule and Changes in Labor Management and Outcome

Abstract

To estimate whether a night-float call schedule for attending obstetricians is associated with different labor management or obstetric outcomes compared with a traditional call schedule. A chart review was performed for all women admitted for labor and delivery during two 3-month periods. One period occurred immediately before a single group of generalist obstetricians changed from a traditional call schedule to a night-float call schedule, whereas the second 3-month period occurred immediately after this change. A control group of women who were managed during the same 6-month time period by a group of generalist obstetricians at the same institution who did not alter their traditional call schedule was also identified. Data on labor management and perinatal outcomes were collected. Change to a night-float call schedule was associated with a decreased use of induction of labor (30% to 16.7%, P=.02). Physicians also were more likely to use oxytocin augmentation (57.5% to 75.0%, P=.01) and less likely to manually extract the placenta (5.0% to 0%, P=.02) or perform an episiotomy (10.1% to 2.6%, P=.04). There were fewer observed third-degree and fourth-degree lacerations (10.3% to 3.3%, P=.045) and fewer neonates born with an umbilical artery pH less than 7.10 (9.3% to 2.2%, P=.03). A night-float call schedule was associated with both a reduction in obstetric interventions, such as labor induction and episiotomy, and improvement of particular obstetric outcomes, such as the frequency of perineal lacerations. II.